The CMS de­clined to al­low Michi­gan to in­crease cost-shar­ing for its Med­i­caid ben­e­fi­cia­ries, but granted enough other pro­vi­sions of its un­usual take-it-or-leave-it waiver ap­pli­ca­tion to avoid trig­ger­ing a sun­set pro­vi­sion

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in the state leg­is­la­tion that ex­tended el­i­gi­bil­ity for about 600,000 res­i­dents. Michi­gan pro­posed re­quir­ing res­i­dents above the fed­eral poverty level to buy pri­vate plans through Health­Care.gov af­ter they have been en­rolled in Med­i­caid for 48 months, or else see their cost­shar­ing obli­ga­tions rise to 7% of their in­come. The CMS re­jected that pro­posal, but al­lowed other pro­vi­sions that will make it eas­ier for the state to drop peo­ple from the pro­gram, called Healthy Michi­gan.

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